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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 12  |  Issue : 2  |  Page : 63-66

Release of ankyloglossia using diode laser


Department of Periodontics and Oral Implantology, KVG Dental College and Hospital, Sullia, Karnataka, India

Date of Web Publication19-Dec-2018

Correspondence Address:
Dr. Akanksha Samvedi
Aliganj, Banda - 210 001, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdl.jdl_8_17

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  Abstract 

Ankyloglossia is defined as a condition in which the tip of the tongue cannot be protruded beyond the lower incisor teeth because of a short lingual frenulum. The prevalence of ankyloglossia is 4.8%. An unusually short lingual frenum results in complications in speech, oral hygiene, lingual recession, etc. To have a healthy lifestyle, treatment becomes necessary. Lingual frenectomy is the treatment of choice. With the advent of lasers, the treatment has become simple, precise, and less discomfort compared to the conventional. The present case report deals with the treatment of ankyloglossia using 980 nm diode laser.

Keywords: Ankyloglossia, diode laser, frenectomy, tongue-tie


How to cite this article:
Samvedi A, Dayakar M M, Pai P, Philip G, Shivanand H. Release of ankyloglossia using diode laser. J Dent Lasers 2018;12:63-6

How to cite this URL:
Samvedi A, Dayakar M M, Pai P, Philip G, Shivanand H. Release of ankyloglossia using diode laser. J Dent Lasers [serial online] 2018 [cited 2019 Sep 19];12:63-6. Available from: http://www.jdentlasers.org/text.asp?2018/12/2/63/248003


  Background Top


The soft tissue that attaches the underneath of the tongue to the floor of the mouth is denoted as the lingual frenum. This add-on binds the tip of the tongue to the posterior (back) surface of the mandible (lower jaw). Etymologically, “ankyloglossia” originates from the Greek words “agkilos” (curved) and “glossa” (tongue). The first use of the term “ankyloglossia” in the medical literature dates back to the 1960s when Wallace[1] tongue tie as “a condition in which the tip of the tongue cannot be protruded beyond the lower incisor teeth because of a short lingual frenulum.”

Occurrence of ankyloglossia is 4.8% and consequences are more among males at almost a 3:1 ratio.[2]

An unusually short lingual frenum results in complications in speech and oral hygiene maintenance, involves in the progress of gingival recession on the lingual side of the lower front teeth, and also interferes with the stability of mandibular prosthesis.[3]

Based on the length of the free tongue,[4] Kotlow classified ankyloglossia as follows:

Clinically acceptable: normal >16 mm

  • Class I: Mild ankyloglossia 12–16 mm
  • Class II: Moderate ankyloglossia 8–11 mm
  • Class III: Severe ankyloglossia 3–7 mm
  • Class IV: Complete ankyloglossia: <3 mm.


The present case report deals with the treatment of ankyloglossia using diode laser 980 nm bloodless surgery.


  Case Report 1 Top


A 20-year-old male patient visited the department of periodontics with a chief complaint of difficulty in protruding his tongue completely. On complete examination, it was found that the patient was suffering from Class III ankyloglossia [Figure 1]a and [Figure 1]b. The patient was informed about the procedure and a written consent was taken. There was no contradictory finding to the procedure. On the day of the procedure, the patient was anesthetized using topical spray and 2% lignocaine infiltration into the frenum [Figure 1]c. A 980 nm diode laser was used in contact mode with a power setting of 2W and 200 mm diameter optical fiber [Figure 1]d. Both the clinician and the patient wore protective eyeglasses. Frenum was held using mosquito forceps. The tip of the optical fiber was moved from the apex to the base of frenum above and below the forceps to excise the tissue. The remaining fibers at the base of the frenum were excised using horizontal movement of the laser tip. The ablated tissue was mopped using wet gauze piece continuously to take care of the charred tissue and prevents excessive thermal damage to the underlying soft tissue. The attachment of frenum to the alveolar ridge was also excised to prevent recession on the lingual side. Protrusive tongue movement was checked during the procedure [Figure 1]e. Slight bleeding was observed, and no suturing was done [Figure 1]f. The patient was given postoperative instructions and asked to perform tongue exercises and was reviewed after 1 month [Figure 1]g. Healing was uneventful. The patient was again examined after 3 months [Figure 1]h, and he reported increase in tongue mobility following surgery and was at ease.
Figure 1: (a) Thick and short lingual frenulum with anterior insertion. (b) Maximum tongue protrusion. (c) Local infiltration. (d) Diode laser application. (e) Maximum tongue protrusion postoperatively. (f) No suture placed. (g) One-month follow-up. (h) At 3-month protrusive movement

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  Case Report 2 Top


A male patient of age 35 years visited the department of periodontics with a chief complaint of difficulty in protruding his tongue completely and also pronunciation of few words. On complete examination, it was found that the patient was suffering from Class II ankyloglossia [Figure 2]a and [Figure 2]b. The patient was informed about the procedure and a written consent was taken. There was no contradictory finding to the procedure. On the day of the procedure, the patient was anesthetized using topical spray and 2% lignocaine infiltration into the frenum [Figure 2]c. A 980 nm diode laser was used in contact mode with a power setting of 2 W and 200 mm diameter optical fiber [Figure 2]d. Both the clinician and the patient wore protective eyeglasses. Frenum was held using mosquito forceps. The tip of the optical fiber was moved from the apex to the base of frenum above and below the forceps to excise the tissue. The remaining fibers at base of the frenum were excised using horizontal movement of the laser tip. The ablated tissue was mopped using wet gauze piece continuously to take care of the charred tissue and prevents excessive thermal damage to the underlying soft tissue. The attachment of frenum to the alveolar ridge was also excised to prevent recession on the lingual side. Protrusive tongue movement was checked during the procedure [Figure 2]e. No bleeding was observed, and suturing was done with 5–0 resorbable suture materials at the base of the tongue [Figure 2]f. The patient was given postoperative instructions and asked to perform tongue exercises and was reviewed after 1 month [Figure 2]g. Healing was uneventful. The patient was again examined after 3 months [Figure 2]h and [Figure 2]i, he reported increase in tongue mobility following surgery and was at ease.
Figure 2: (a) Lingual frenum with anterior insertion. (b) Maximum tongue protrusion. (c) Area anaesthetised using local infiltration. (d) Diode laser was used to excise the high frenal attachment. (e) Maximum tongue protrusion postoperatively. (f) Five to zero absorbable sutures placed over the wound. (g) One-month follow-up. (h) Three-month postoperative. (i) Three-month follow-up showing completely healed wound

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The pain perception felt by patient 1 was more as compared to patient 2 as well as the stability of the results obtained was more in patient 1 compared to patient 2.


  Discussion Top


Ankyloglossia is associated with X-linked cleft palate and other syndromes such as Kindler, Van der Woude, and Opitz,[5] but the two cases reported did not show any syndrome association. There are various difficulties associated with ankyloglossia such as breastfeeding in neonates, recession, tooth mobility, speech, and malocclusion.

Surgical management of ankyloglossia was majorly classified as frenotomy, frenectomy, and frenuloplasty.[6] The present case report deals with frenectomy that is complete excision of the lingual frenum in both the cases.

The conventional technique to treat ankyloglossia was using scalpel and as the tissue in the lingual of tongue and floor of the mouth is highly vascularized, intraoperative bleeding is a major discomfort to the clinician and the patient.

With the advent of lasers in the field of periodontology, the treatment of ankyloglossia has become quite simple for the clinician as well as the patient in terms of less postoperative discomfort. There are several advantages of using lasers in surgical therapy. Wigdor et al. described the advantages of lasers over surgical procedures as follows:

  1. Dry and bloodless surgery
  2. Instant sterilization of the surgical site
  3. Reduced bacteremia
  4. Reduced mechanical trauma
  5. Minimal postoperative swelling and scarring
  6. Minimal postoperative pain.[7]


Bader (2000) listed the same advantages in his discussion of soft-tissue surgery and specified that when frenectomy is performed in younger patients, the laser is particularly gentle compared with traditional surgery. Since the floor of the mouth is highly vascularized, using lasers in this area for incision or excision is advantageous as they provide excellent hemostasis; therefore, a clear field to operate and the need for suturing is reduced significantly.[8]

Laser wound results in minimal or no bleeding, which is due to sealing of capillaries by protein denaturation and stimulation of clotting factor VII production. The thermal effect of laser seals the capillaries and lymphatics, which also reduce the postoperative bleeding and edema.[9]

Laser-assisted lingual frenectomy is simple with excellent precision and less discomfort both to the patient and the operator compared to the conventional technique. High level of sterilization is maintained in diode treatment, which reduces the need for postoperative antibiotic care.

Histologically, laser wounds have been found to contain significantly lower number of myofibroblasts.[10] This results in less wound contraction and scarring, and ultimately improved healing. The results obtained with patient 1 showed wound contraction postoperatively, which could be attributed to no suture placement as compared to patient 2 who showed stable results at 1 month and 3 months.

Laser-assisted frenectomy provides better postoperative perception of pain and function than with the scalpel technique.[11] The increased pain perception felt by patient 1 compared to patient 2 can be attributed to no suture application, healing by secondary intention, and large open wound.


  Conclusion Top


Tongue-tie is in most cases a relatively harmless condition, and the treatment if needed is often relatively simple and safe when combined with a laser unit. Lingual frenectomy procedures are more challenging due to the hypermobility of the tongue and the proximity to the submandibular ducts and the highly vascular floor of the mouth. Hence, the use of lasers should be considered before taking up a blade.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Wallace AF. Tongue tie. Lancet 1963;2:377-8.  Back to cited text no. 1
    
2.
Messner AH, Lalakea ML, Aby J, Macmahon J, Bair E. Ankyloglossia: Incidence and associated feeding difficulties. Arch Otolaryngol Head Neck Surg 2000;126:36-9.  Back to cited text no. 2
    
3.
Laskin DM. Oral and Maxillofacial Surgery. Vol. 1. St. Louis: The CV Mosby Company; 1989. p. 360.  Back to cited text no. 3
    
4.
Kotlow LA. Ankyloglossia (tongue-tie): A diagnostic and treatment quandary. Quintessence Int 1999;30:259-62.  Back to cited text no. 4
    
5.
Forbes SA, Brennan L, Richardson M, Coffey A, Cole CG, Gregory SG, et al. Refined mapping and YAC contig construction of the X-linked cleft palate and ankyloglossia locus (CPX) including the proximal X-Y homology breakpoint within xq21.3. Genomics 1996;31:36-43.  Back to cited text no. 5
    
6.
Flocken JE. Electrosurgical management of soft tissues and restorative dentistry. Dent Clin North Am 1980;24:247-69.  Back to cited text no. 6
    
7.
Wigdor HA, Walsh JT Jr., Featherstone JD, Visuri SR, Fried D, Waldvogel JL, et al. Lasers in dentistry. Lasers Surg Med 1995;16:103-33.  Back to cited text no. 7
    
8.
Bader HI. Use of lasers in periodontics. Dent Clin North Am 2000;44:779-91.  Back to cited text no. 8
    
9.
Pirnat S. Versatility of an 810 nm diode laser in dentistry: An overview. Laser Health Acad 2007;4:19.  Back to cited text no. 9
    
10.
Zeinoun T, Nammour S, Dourov N, Aftimos G, Luomanen M. Myofibroblasts in healing laser excision wounds. Lasers Surg Med 2001;28:74-9.  Back to cited text no. 10
    
11.
Haytac MC, Ozcelik O. Evaluation of patient perceptions after frenectomy operations: A comparison of carbon dioxide laser and scalpel techniques. J Periodontol 2006;77:1815-9.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2]



 

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Abstract
Background
Case Report 1
Case Report 2
Discussion
Conclusion
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